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Cited by 22Transcranial Magnetic Stimulation StudiesTraumatic Brain Injury ResearchFunctional Brain Connectivity Studies

Neural mechanisms of emotional health in traumatic brain injury patients undergoing rTMS treatment

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Sultana, Tajwar, Hasan, Muhammad Abul, Kang, Xiaojian, Liou-Johnson, Victoria, Adamson, Maheen Mausoof, Razi, Adeel·2023·Molecular Psychiatry
DOI 10.1038/s41380-023-02159-zPMC PMC11041778

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Abstract

Emotional dysregulation such as that seen in depression, are a long-term consequence of mild traumatic brain injury (TBI), that can be improved by using neuromodulation treatments such as repetitive transcranial magnetic stimulation (rTMS). Previous studies provide insights into the changes in functional connectivity related to general emotional health after the application of rTMS procedures in patients with TBI. However, these studies provide little understanding of the underlying neuronal mechanisms that drive the improvement of the emotional health in these patients. The current study focuses on inferring the effective (causal) connectivity changes and their association with emotional health, after rTMS treatment of cognitive problems in TBI patients ( N = 32). Specifically, we used resting state functional magnetic resonance imaging (fMRI) together with spectral dynamic causal model (spDCM) to investigate changes in brain effective connectivity, before and after the application of high frequency (10 Hz) rTMS over left dorsolateral prefrontal cortex. We investigated the effective connectivity of the cortico-limbic network comprised of 11 regions of interest (ROIs) which are part of the default mode, salience, and executive control networks, known to be implicated in emotional processing. The results indicate that overall, among extrinsic connections, the strength of excitatory connections decreased while that of inhibitory connections increased after the neuromodulation. The cardinal region in the analysis was dorsal anterior cingulate cortex (dACC) which is considered to be the most influenced during emotional health disorders. Our findings implicate the altered connectivity of dACC with left anterior insula and medial prefrontal cortex, after the application of rTMS, as a potential neural mechanism underlying improvement of emotional health. Our investigation highlights the importance of these brain regions as treatment targets in emotional processing in TBI.

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  • The DLPFC plays a critical role in emotion regulation, working memory, and executive functioning; these are impaired in individuals with a history of concussion and shown to improve after rTMS targeted at the DLPFC.

    “In addition to its role in depression, the DLPFC plays a critical role in emotion regulation, working memory, and executive functioning. These are all impaired in individuals with a history of concussion and shown to improve after rTMS targeted at the DLPFC (22, 23).”

    From Adaptive trial for the treatment of depressive symptoms associated with concussion using accelerated intermittent theta burst stimulation (ADEPT): rationale, design and methods (2025) · cites this paper as [23]

    The Results (Behavioral analysis; page unavailable) report improved emotional-health scores after rTMS, and the Conclusion says stimulation of the left DLPFC helped emotional health in patients with TBI. But the Conclusion explicitly says it failed to influence executive function. The cited passages do not establish improved working memory or improvement across all three functions in people with a history of concussion. (LLM, conf=0.91)

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Authors
Sultana, T., Hasan, M. A., Kang, X., Liou-Johnson, V., Adamson, M. M., & Razi, A.
Affiliations
  • NED University of Engineering and Technology (PK)
  • VA Palo Alto Health Care System (US)
  • Canadian Institute for Advanced Research (CA)
Corresponding author
Razi, Adeel
ORCID
Venue
Molecular Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2023-07-06
Volume
28
Issue
12
Pages
5150-5158
ISSN
  • 1359-4184 (ISSN-L)
  • 1476-5578
DOI
10.1038/s41380-023-02159-z
PMC
PMC11041778
OpenAlex
W4383371964
Cited by
22
References
97
Citations by year
2026: 3 · 2025: 7 · 2024: 9 · 2023: 3
FWCI
2.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Psychiatry (publishedVersion, cc-by)
  • medRxiv (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Greater South Information System
Funders
  • Department of Education and Training | Australian Research Council (DP200100757, DE170100128)
  • Department of Health | National Health and Medical Research Council (1194910)
  • Wellcome Trust (203147/Z/16/Z)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
Keywords
mild traumatic brain injury, repetitive transcranial magnetic stimulation, emotional well-being, emotional dysregulation, effective connectivity, dynamic causal modeling, dorsolateral prefrontal cortex, dorsal anterior cingulate cortex, anterior insula, medial prefrontal cortex, cortico-limbic network, default mode network, salience network, frontoparietal network, neuromodulation, depression
MeSH terms
Brain Injuries, Traumatic, Dorsolateral Prefrontal Cortex, Adult, Brain, Brain Mapping, Emotions, Female, Gyrus Cinguli, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Nerve Net, Neural Pathways, Transcranial Magnetic Stimulation, Young Adult

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